Failure to Provide Full-Time DON Not Serving as Charge Nurse with Census Over 60
Penalty
Summary
The facility failed to provide a full-time Director of Nursing (DON) who did not serve as a charge nurse when the resident census exceeded 60, as required by both facility policy and federal regulations. At the time of the survey, the census was 105 residents. The facility's policy defined full-time as 40 or more hours per week and specified that the DON may only serve as a charge nurse if the census is 60 or fewer. Review of staffing records and interviews revealed that the DON was on medical leave, and there was uncertainty among staff regarding who was fulfilling the DON role during this period. The RN Supervisor was identified as the interim DON, but also provided RN coverage on several days, which conflicted with the policy prohibiting the DON from serving as a charge nurse when the census is above 60. Further interviews confirmed that on specific days, the facility did not have an interim DON present, and RN staff from corporate provided coverage intermittently. The lack of a consistent, full-time DON who was not also serving as a charge nurse was discussed in the facility's QAPI meeting, and there was consideration of the DON performing some duties remotely. However, at the time of the survey, the facility was not in compliance with the requirement for a full-time DON who was not assigned as a charge nurse, given the census of 105 residents.